Electroconvulsive Therapy in Super Refractory Status Epilepticus: Case Series with a Defined Protocol

Area of Science:

• Neurology
• Neurosurgery
• Critical Care Medicine

Background:

• Super-refractory status epilepticus (SRSE) is a severe neurological emergency with high morbidity and mortality.
• SRSE is defined by its resistance to third-line antiepileptic drugs and anesthetic agents.
• Electroconvulsive therapy (ECT) is a non-pharmacologic treatment option for refractory epilepsy, but its efficacy in SRSE is understudied.

Observation:

• A protocol for ECT in SRSE was developed based on clinical guidelines.
• Six patients with SRSE, refractory to standard treatments including pharmacologic coma, received ECT.
• The objective of each ECT session was to induce a motor seizure lasting at least 20 seconds.

Findings:

• SRSE resolved in all six patients after several days of treatment that included ECT.
• No relevant adverse effects were observed during or after ECT sessions.
• ECT demonstrated feasibility and effectiveness in managing SRSE.

Implications:

• ECT presents a viable and effective therapeutic option for super-refractory status epilepticus.
• Further research is warranted to establish ECT's role in the treatment algorithm for SRSE.
• The non-invasive nature and uncommon adverse effects of ECT support its consideration in SRSE management.